Prevention and Treatment of Common Hyperglycemia in Surgery Pilot (PATCHS Pilot)

Prevention and Treatment of Common Hyperglycemia in Surgery (PATCHS): A Randomized, Controlled, Pilot Study

The PATCH pilot trial aims to establish feasibility and determine the sample size of a future, large-scale, multi-site RCT, as well as reinforce the long-standing known safety profile of glucose, insulin, and potassium (GIK) and explore the physiologic response. We hypothesize that the use of GIK in non-diabetic patients undergoing abdominal surgery, will reduce rates of morbidity & death compared to standard of care treatment. In brief, primary outcomes of interest include estimation of the standard deviation (to derive a sample size estimation) and the ability to recruit target population, assessment of patient compliance/burden, and assessment of provider compliance/burden (feasibility).

Study Overview

• Status: Completed
• Conditions: Surgery; Non Diabetic Hyperglycemia
• Intervention / Treatment: Drug: Crystalloid Infusion; Drug: glucose, insulin, and potassium (GIK)

Detailed Description

Elevated glucose levels during surgery are common and dramatically increase the risk of morbidity and mortality. This has been identified in multiple statewide quality improvement collaboratives, with a monotonic relationship between increased glucose levels and higher risks of almost all adverse events. While perioperative glucose management tends to focus on those with diabetes, some degree of perioperative hyperglycemia occurs in as much as two thirds of non-diabetic patients.

A recently identified phenomenon is that, at the same levels of hyperglycemia, non-diabetic patients have a much greater risk of death and complications compared to patients with diabetes. Given that hyperglycemia is typically considered a problem for people with diabetes, this finding has been described as a hyperglycemia paradox. Unfortunately, treatment with insulin can only happen after hyperglycemia has been recognized, and since non-diabetic patients are often not monitored for hyperglycemia, hyperglycemia is likely to be under-recognized. Moreover, addressing hyperglycemia after the fact may not be as effective in reducing adverse events as preventing hyperglycemia.

There is a long history of using perioperative insulin in patients undergoing at least one type of surgery. For over 45 years cardiac anesthesiologists have been testing the benefits of insulin combined with glucose and potassium (GIK) in cardiac surgery. In more than 30 RCTs, including more than 2000 patients with and without diabetes, GIK prophylaxis has been shown to be safe, with < 1 in 200 participants experiencing hypoglycemia secondary to the inclusion of glucose in the formulation. Moreover, these studies have found large reductions in surgically induced inflammation and often significant improvements in clinical outcomes.

• Study Type: Interventional
• Enrollment (Actual): 106
• Phase: Phase 4

Contacts and Locations

Study Locations

• United States
  • Washington
    • Seattle, Washington, United States, 98195
      • University of Washington Medical Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Adults 18 years of age or older
2. Patients undergoing abdominal surgery planned to last greater than 4 hours with inpatient admission
3. Patients at UWMC - Montlake

3. Makes their own medical decisions: patient is deemed to have decisional capacity by the medical team and does not have a surrogate such as a spouse, partner, or caretaker making the decision on their behalf. Examples include patients with severe dementia or other cognitive limitations

Exclusion Criteria:

1. Known diagnosis of diabetes or altered glucose homeostasis during preoperative evaluation (single fasting blood sugar≥126 mg/dL or HbA1C≥6.5 percent).

2. Known diagnosis of chronic kidney disease (moderate-to-severe, or worse)

   • BMP within 6 months of screening is required. Patients with stage 3b (moderate-to-severe) kidney disease or worse (i.e. eGFR ≤ 30) will be excluded. Patients with a potassium reading greater than 5.5 at any point within the 6-month period will also be excluded.
3. Patients receiving chronic systemic steroids.
4. Patients undergoing cardiac or solid organ transplant procedures.
5. Surgery planned to last less than 4 hours.
6. Outpatient surgery
7. Pregnant people
8. Current UW Medicine or UW Dentistry residents and fellows
9. Known hypersensitivity to potassium, glucose, insulin, or any of its excipients.
10. Enrollment in another therapeutic study
11. Any serious underlying medical or psychiatric condition, dementia, altered mental status or any issue that would impair the ability of the patient to receive or tolerate the planned treatment, to understand informed consent or that in the opinion of the investigator would contraindicate the patient's participation in the study or that would confound the results of the study.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Placebo Comparator: Standard Care; Subjects in the standard care/placebo arm will receive only regular crystalloid.	Drug: Crystalloid Infusion; placebo
Active Comparator: GIK; Subjects in the glucose, insulin, and potassium (GIK) arm will receive regular crystalloid with GIK added.	Drug: Crystalloid Infusion; placebo; Drug: glucose, insulin, and potassium (GIK); GIK formulation: 100 g/L glucose, 33 U/L insulin, and 40 mmol/L KCl Reference PMID: 32151220. Formulation represents a 50% reduction in compounded solute combination from the reference study, which allows for administration via peripheral IV.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
30-day Clinical NSQIP-defined serious adverse events	Estimate the standard deviation in support of anticipated, large-scale RCT for the outcome 30-day Clinical NSQIP-defined serious adverse events	30 days
Patient compliance/burden	Number patient refusal events vs enrolled	1 day
Ability to recruit the target population	Number of patients screened per month vs number of patients enrolled per month	1 day
Provider compliance/burden	Number of times GIK stopped for 20 minutes	1
Safety	Number of AEs and SAEs, thought to be at least possibly related to treatment, as well as associated AE type	1 day

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of hyperglycemic and hypoglycemic events	hyper- (BG>180) and hypoglycemic (BG <70)	1 day
Length of stay in hospital	Defined in post-op days	30 days

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Postoperative inflammation	Collect C-reactiev protein lab values	1 day
Postoperative inflammation	Collect blood cell count (CBC) lab values	1 day

Collaborators and Investigators

• Sponsor: University of Washington
• Investigators: Principal Investigator: David Flum, MD, MPH, University of Washington

Publications and helpful links

General Publications

• Whitehead AL, Julious SA, Cooper CL, Campbell MJ. Estimating the sample size for a pilot randomised trial to minimise the overall trial sample size for the external pilot and main trial for a continuous outcome variable. Stat Methods Med Res. 2016 Jun;25(3):1057-73. doi: 10.1177/0962280215588241. Epub 2015 Jun 19.
• Zhao K, Zhang Y, Li J, Cui Q, Zhao R, Chen W, Liu J, Zhao B, Wan Y, Ma XL, Yu S, Yi D, Gao F. Modified Glucose-Insulin-Potassium Regimen Provides Cardioprotection With Improved Tissue Perfusion in Patients Undergoing Cardiopulmonary Bypass Surgery. J Am Heart Assoc. 2020 Mar 17;9(6):e012376. doi: 10.1161/JAHA.119.012376. Epub 2020 Mar 10.

Study record dates

Study Major Dates

• Study Start (Actual): September 4, 2024
• Primary Completion (Actual): September 28, 2025
• Study Completion (Actual): January 1, 2026

Study Registration Dates

• First Submitted: September 25, 2024
• First Submitted That Met QC Criteria: September 30, 2024
• First Posted (Actual): October 3, 2024

Study Record Updates

• Last Update Posted (Actual): February 23, 2026
• Last Update Submitted That Met QC Criteria: February 19, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Metabolic Diseases; Glucose Metabolism Disorders; Hyperglycemia; Hormones; Hormones, Hormone Substitutes, and Hormone Antagonists; Peptide Hormones; Peptides; Amino Acids, Peptides, and Proteins; Carbohydrates; Inorganic Chemicals; Metals, Alkali; Elements; Metals, Light; Metals; Sugars; Insulins; Pancreatic Hormones; Proinsulin; Hexoses; Monosaccharides; Insulin; Glucose; Potassium
• Other Study ID Numbers: STUDY00019463

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No